Having torn once during labour, is our reader likely to tear again? Our midwife advises...

Raisingkids member's problem
I sustained a fourth degree tear when my one year old son was born. Is it likely that I will need a c-section to deliver my next baby? Fortunately I have healed well and do not have any problems.

Midwife Genevieve Kingston's Advice
Having had a fourth degree tear shouldn't make you a necessary candidate for caesarian section. However if it is something you wished to have, it would give you more grounds to ask for one.

Any scar tissue in the perineal area is more likely to tear when under pressure, as scar tissue is rigid and does not thin as much. But this does not mean that you will definitely have a second fourth degree tear.

If you wished to have a vaginal delivery, it would be well worth discussing preventative measures. Awful though it sounds, an episiotomy is something that could be considered. The reason for this is that the incision would take the pressure away from the scar tissue and therefore you should not tear along the previous tear line.

Unfortunately nothing is guaranteed. Some midwives recommend perineal massage, antenatally, with oil to soften up the perineum, increasing the elasticity and hopefully reducing the friablity of the tissue (ie. how easily the tissue tears).